Emmanuel Macron paves the way for active assistance in dying

by time news

What will be the end-of-life “French model”? At the end of the reception at the Élysée, Monday, April 3, of the 184 participants in the Citizens’ Convention who came to present their final document to him, President Macron sketched the outlines and specified the method which will come to refine the line. Act 2 of the great national debate launched in the fall of 2022 must therefore take shape around a bill “coconstructed” between the government and the Parliament – ​​National Assembly and Senate – in consultation with the actors concerned, which must be presented “before the end of summer 2023”.

Active assistance in problematic dying

Taking up the main recommendations of the Convention, the Head of State sees this system as based on two “pillars”, one of which is to be consolidated, the other still to be built. The first, subject to a very broad consensus among the citizens of the Convention, concerns the current framework for supporting patients at the end of life, which must be strengthened “by better applying the Claeys-Leonetti law of 2016”underlined Emmanuel Macron, in particular by developing a “universal access”for everyone and everywhere on the territory, to palliative care.

The second pillar, less consensual, concerns openness to active assistance in dying. On this point, the Citizens’ Convention brought out a strong majority in favor of changing the law, but opinions remain divided on the methods to be adopted – euthanasia, assisted suicide, assisted suicide with the exception of euthanasia, or both. choice – and the criteria to be used – of age, nature of the illnesses and suffering endured, vital prognosis.

President’s concern for harmony and desire to appease

To decide between the various options on the table, the president chose not to decide alone. Is it because his « conviction » is still insecure? “I have a personal opinion on the matter which, like that of many French people, can evolve, evolves, will evolve, who knows? », he acknowledged. But it’s mostly “out of a spirit of responsibility, concern for harmony and a desire to appease” that he decided to rely on a text to be drawn up between the executive and the legislature, and this in a relatively short time.

Concretely, it is now up to the Prime Minister, Élisabeth Borne – or her possible successor – to bring together, in the days or more likely the weeks to come, the presidents of the two chambers – the Renaissance deputy Yaël Braun-Pivet for the Assembly national, LR Gérard Larcher for the Senate – in order to define a roadmap. It is up to them to consult the presidents of the various political groups with a view to setting up a cross-party commission responsible for drafting a text that is as consensual as possible.

The task will not be easy because it is not certain that a bill opening to active assistance in dying, even very framed, will obtain the support of the right, rather opposed to a development of this type, even if freedom of conscience will be left to everyone at the time of the vote. We remember that in April 2021 the deputies Les Républicains had blocked, by a host of amendments, the bill giving “right to a free and chosen end of life” presented by the elected Modem of Charente-Maritime Olivier Falorni.

“Red lines” and “safeguards”

In the courtyard of the Élysée, Olivier Falorni still wants to believe it. “All of the end-of-life laws adopted so far have come from private bills. The way is narrow, but it exists. The work of the Convention has been remarkable, now is the time to take action”he blurts out.

Regardless of the success or otherwise of the forthcoming parliamentary initiative, President Macron has already set some “red lines” not to cross. Some take up the “safeguards” posed by the Convention members, such as the need to ensure the discernment of the patient who requests active assistance in dying and to impose strict medical conditions on his access. “Active assistance in dying cannot be a response to social distress or isolation”, specified the Head of State. Firmer still, he totally excluded that a minor could access it, as some of the citizens of the Convention considered.

Strengthening the current support framework should not pose any particular political problem, as opinions converge on this subject. In its opinion 139 published on September 13, 2022, the National Consultative Ethics Committee (CCNE) thus recalls that it would not be “not ethical to consider a change in legislation” without taking the necessary measures to develop palliative care. Recommendation taken up by the parliamentary evaluation mission of the Claeys-Leonetti law in its conclusions made public on Wednesday 29 March and by the final document adopted by the Convention on Sunday 2 April.

Palliative care: towards a ten-year plan

In this regard, President Macron clarified that a “10-year national plan with the necessary investments” will be presented in the coming weeks. At the Ministry of Health, the services of Minister Delegate Agnès Firmin Le Bodo have been working for several weeks to develop this ten-year strategy which will strengthen the 5th palliative care development plan 2021-2024.

“A first step will be taken in May with the release of an instruction to completely renovate the organization of palliative care regulated by a circular dating from 2008”, says his cabinet. In particular, the issues of care for minors at the end of their lives, patients residing in nursing homes or the dissemination of a « culture palliative » throughout the medical world.

In terms of method, this strategy will be based on the model of that adopted for the cancer plan. “The general idea is to better anticipate the care of patients by setting up care pathways from the diagnosis, which can be deployed from hospital to home, also ensuring the support of caregivers”continues the minister’s office.

Then comes the definition of short, medium and long-term objectives to fill the lack of beds and staff, training needs, research… “A project that will take a few more months because it is not an evolution but a real revolution”says the ministry.

It remains to be seen whether the State will have the financial means for its ambitions. “We have an obligation of result to be built over time. We will move towards the French end-of-life model and this path will be different thanks to you”, pledged President Macron to the citizens of the Convention. Coming out of the Élysée Palace, Julian, one of the 184 participants, showed cautious optimism: “I hear an ambition. But I’m waiting to see. »

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Palliative care, an insufficient supply

At the end of 2021, France had 7,546 hospital beds dedicated to palliative medicine, including 1,980 in 171 palliative care units and 5,566 beds identified as palliative care within hospital departments.

To this must be added 420 mobile teams palliative care who bring their expertise and support to caregivers in charge of the patient, at home, in nursing homes or in hospital.

Finally, there are 23 “regional resource teams” who take care of minors at the end of life, from newborns to adolescents.

There are still strong territorial inequalities: 20 departments still do not have units palliative care and about twenty remain under-equipped with specialized beds.

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